Analysis Of Risk Factors Related To Infection In Patients With Liver Failure Treated With Artificial Liver Support

Objective: To analyze the risk factors of infection in patients with liver failure who accepted artificial liver support therapy,and provide the guideline for clinicians to take effective measures to reduce the infection rate and improve the survival rate.Methods:We collected the clinical data of patients who diagnoses as liver failure from January 2012 to November 2016 in the first affiliated hospital of Bengbu Medical College,such as gender,age,liver function,coagulation function,catheter indwelling time,whether accepted the antibiotics,and whether occur complications,type of liver failure,Child-Pugh score,MELD score,peripheral blood platelet leukocyte count,neutrophil count,etc.The patients were divided into two groups: accepted artificial liver therapy group and non artificial liver therapy group.The non artificial liver group was treated with comprehensive medical treatment,while the artificial liver group was treated with comprehensive medical treatment and artificial liver support.Retrospective analysis of curative effect and infection difference in two groups;then the artificial liver group was divided into infection group and non infection group,to seek the related risk factors of liver failure patients with secondary infection by using regression analysis.Results:The level of ALT,AST and TBIL compared to the baseline level decreased significantly,the level of CHE,ALB and PTA compared to the baseline level increased significantly in ALSS group;the level of ALT,AST and TBIL compared to the baseline level decreased significantly,the level of ALB and PTA compared to the baseline level increased significantly in non ALSS group,and the difference was statistically significant.There was no significant difference between CHE and ALT before and after treatment.The level of ALT,AST,CHE,TBIL,ALSS,PT and PTA before and after treatment in ALSS group decreased or increased more significantly than the non ALSS group,the difference was statistically significant(P<0.05).The improvement rates of ALSS group and non ALSS group were 53.04% and 44.29% respectively,and the difference was not statistically significant(P>0.05).36.08%(92/255)of patients with liver failure infected,the infection rate of ALSS group and non ALSS group were40.87%(47/115)and 32.14%(45/140)respectively,and there was no statistically significant between the two groups(?2=2.085,P>0.05).The common infection sites were lower respiratory tract(40.17%),abdominal cavity(27.45%),upper respiratory tract(11.76%),intestinal(7.84%)and blood flow(5.88%).17.39% infected patients showed two infection sites.Through the single factor analysis of logistic we find the risk factors of infected patients in ALSS group were Child-Pugh grade,MELD score,PTA,prophylactic use of antibiotics,indwelling time and complications(OR value were1.051,1.019,0.968,0.128,1.114,5.170 respectively),and through the logistic regression analysis we find the main risk factors of infected patients in ALSS group were the complication and indwelling time of catheter(OR value were 11.590 and 1.253respectively).Conclusion: Comprehensive medical treatment can effectively improve liver function and blood coagulation function in patients with liver failure and combined with artificial liver support therapy have better curative effect;the infection rate of artificial liver group was higher than that of non artificial liver group,and secondary infection is an important reason for poor prognosis in patients with liver failure;Child-Pugh score,MELD score,PTA,PLT,complication and preventive application of antibiotics and catheter duration are related risk factors of patients with infection of liver failure with artificial liver support therapy,and complications and catheter duration are the independent risk factors.